Fri Aug 15, 2008 at 15:45

There are some progressive policy changes that are fairly simple, easy to achieve with electoral success. All it took, for example, to get a minimum wage increase was to elect a Democratic Congress. All it took to start investigating executive branch malfeasance was to give Henry Waxman a gavel. Having the EPA and OSHA issue better regulations requires only a President who will appoint better people to run those agencies. Lots of other things are harder, requiring the combination of both electing a more progressive President and making our progressive movement stronger. To get a dramatically improved trade policy will take not only an Obama Presidency but a powerful movement demanding that Obama do the right thing on trade. But even so, that kind of change, as big and important as it is, is not terribly complicated to actually pull off- it just requires a President willing to do it.

There are, however, some issues that are big, complicated messes to try to make real change in. Really shrinking the power of our military-industrial complex so that there won't be a constant political pressure for more military adventurism fits in that category. So does fundamentally charging our carbon fuel based economy so that we can truly solve the climate crisis. And restructuring 1/6 of our economy, health care, is going to be incredibly tough as well.

I think we are likely going to have to wait to do much regarding the first of these, the military-industrial complex issues, because while Obama will at least start to move us out of Iraq, he probably won't look to make major change in general on national security policy. The other two issues, though, we have a shot at- Obama says he wants to make them a priority.

Given that, I want to go back to discussion that has graced the pages of OpenLeft from time to time, which is about theories of how you can create change, in this case specifically the kind of big change desperately needed regarding health care and climate change. I want to compare the big theories of change that one hears most often, and start a discussion on how the progressive community should focus its energies.

Before going down the list of theories, I want to stop for a moment on the topic of whether big change is even possible, because if past experience is any guide, I will be seeing comments on this post within a few minutes of putting it up from people who believe big change is impossible. Obama is no true progressive, they will say; or Democrats in Congress suck; or Republican filibusters can never be beaten; or the drug industry lobbyists are too strong; or the media is too much in the pocket of the bad guys. What I believe is that all of these arguments and obstacles need to be taken into account, but to give up now before the battle is even engaged is pure chickenshit- a combination of cynicism and cowardice that makes no sense.

So if you aren't ready to give up the battle before we even begin, join me in this discussion. Here are the big theories of change:

1. The Obama theory, which is that a combination of inspiring the American people to take action and reaching across the aisle in a bipartisan way will get the job done.

2. The "elect enough Democrats" theory. This is the theory stated by Democratic leadership (and some others) whenever we fail on a major issue: if we just elect more Democrats we can overcome filibusters, overcome Blue Dogs, etc.

3. The "elect more AND better Democrats" theory. This is the theory popular with BlogPAC and other good progressives that the key to big change is to focus on electing more progressive Democrats.

4. The "build a broad powerful coalition" theory. This is the HCAN theory that building a big broad coalition of organizations around bottom line principles is the key to winning.

5. The "strange bedfellows" theory. This is the view, espoused by FamiliesUSA and some other groups on health care, along with Al Gore on climate change, that the key to passing big change is to assemble a strange bedfellows coalition of business and labor, consumers and providers, and relevant industry people, conservatives and moderates and liberals.

6. The more powerful progressive movement theory. This is the theory that says that we can only get big change by building a more powerful and more unified progressive movement.

7. The winning popular opinion theory. This theory ascribes to the idea that if we can just convince broad majorities of the country on our issue, they will demand change and politicians will respond.

Those are the main theories that I hear people espousing, although I would be very interested in hearing any more theories people have regarding getting big change legislation on health care, climate change, or other complicated issues passed. Some points I want to make about this list of change theories:

First, a point that seems obvious to me, but I want to make it because I find that sometimes people argue that their pet theory is the only way to go: these strategies for change are mostly not mutually exclusive. A President Obama inspiring the masses, electing more Democrats, electing better Democrats, building a big coalition, building a stronger progressive movement- none of those things is in conflict with the other, and all of them help to one extent or the other. Even reaching out to some Republicans and doing the strange bedfellows thing don't have to be bad things, as long as Obama said no to bad ideas coming from those bedfellows that comprised the goals of the reform we are looking for, and as long as theory didn't help legitimize the bad actors like Newt Gingrich per Stoller's post regarding Gore's ad.

All of us should focus on the strategies we most believe in, even as we debate what combination of them we need to move on to win. We should also all acknowledge there are weaknesses with each theory- big change will not happen easily.

Second, one thing I am not clear about with the folks pushing for the strongest left position on the big issues, like the single-payer folks on health care, is their theory of change. I would be very interested in having a dialogue about it, because I love the idea of a single-payer system, but have never heard a theory I found reasonable regarding how we actually get one anytime in the next decade or two. If those of you most passionate about single-payer have some thoughts about that, I would love to hear them.

Part of the question I raised above, and part of the broader discussion about theories of change in general, is related to timing. Keeping in mind that in the long run we really will all be dead; that I have been organizing for universal health care for 30 years and I'm a mere pup compared to some of my senior citizen friends who fought for Medicare and Medicaid in the 1960s, and saw them as the first step toward universal; that Al Gore held the first hearing on global warming in the late 1970s, and that we really don't have a whole lot of time before climate change becomes climate catastrophe: it is important that we start to actually make real progress on these issues. For those folks who lack faith in our current elected officials (quite understandably), and who tend to ascribe primarily to longer-term strategies like electing better Democrats, or fighting for single-payer, I think it's important to give those of us who are more antsy for real progress now a sense of (a) your timeline and (b) how we can get real things done now even as we are waiting for the big break through someday in the future.

My own view is that virtually all the theories I've laid out are deeply flawed on their own. Obama can't inspire enough people on his own, we won't elect enough Democrats anytime soon even in a great cycle, we can't elect enough better Democrats fast enough, our coalitions and broader movement are not strong enough- none of this works by itself. We may be coming to a moment in time when our problems are big enough and a broad majority of Americans recognize it, that all of these theories in combination will create a moment of big change. That's what happened in the 1960s and 1930s, in the turn of the century Progressive era, in the fiery cauldron of the Civil War years. We may be coming to such a moment soon, and in the meantime we progressives should be having honest conversations with each other over what strategies we can be pursuing to best take advantage of it.

I've always thought public opinion on a particular issue was a big one, and that
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it means the president has to run on that issue and win, to get the necessary ratification of opinion (ie, it's not just something people think, it's something they vote on).

If you have all the voting power you need, but can get demagogued on the issue itself, then it's hard to do much (Clinton had all the voting power he needed for gays in the military, right?). But if you have the voting power AND public opinion, you become a steamroller that the other side has to jump onto.

I was hoping to see a lot more argument about climate change in this election. Obama hasn't begun his general election issues campaign, so we have yet to see how much emphasis he puts on it. But I keep hoping that he runs really centrally on it, so that with our big Democratic troika we can actually pass a BIG bill, not something the Chamber of Commerce wrote for Steny Hoyer.

6. The more powerful progressive movement theory. This is the theory that says that we can only get big change by building a more powerful and more unified progressive movement.

This of itself is open to a number of suboptions. I personally espouse in the context of the U.S. a broader and more decentrailized powerful progressive movement (which is really lots and lots of submovements and groups and people organizing into various formations). The tactics and strategies for building such a movement would differ from building a more "unified" progressive movement, one would have a more dispersed but stronger effect, imo. Basically, it relies on the interaction of movement buillding and discourse transformation, not on movement building for building concentrated power. It's like a swarm instead of a phalanx.

The other major point I have is the question of transforming structures (the electoral college, the senate, the Constitution as a whole) - and what role this plays alongside, complementing and at times transcending a policy agenda. So, for example, I would like the immigration policy agenda to include a plank for a consituttional amendment to effectively ban deportations on political (and other selective) grounds because this is a primary way in which ideological diveresity is limited in the U.S. It isn't narrowly to do with immigration per se, but it ought to bring together radicals, progressives, committed liberals, and immigration advocates along with people from minority groups who are aware of the contibutions of Marcus Garvey, Emma Goldman, etc. Just an example for conversation.

On health care, i think the only way that the u.s. is going to get a single-payer system is either by letting the present crisis continue to a breaking point, or, more likely, to make piecemeal reforms along the lines of what Obama or Hillary Clinton suggest to gradually increase the number of people covered and then as the political power of progressive mounts over time, and, when the time is right, strike for a fundamental overhaul of the system. But you need victories along the way if you're to keep it an issue. For now, "health care reform" unites major corporations that are under severe pressure and would additionally benefit from a taxpayer funded system to provide healthy workers and advocates of more rationalized financing and ordinary people who need more and better health care. However, those interests will diverge at some point, and progressives need to be ready with a plan, the power to push it through, and considered ways of overwhelming the counterforces. I like this strategy because it increases coverage and incentives, attacks the discourse that the government can't do anything right, and simultaneously builds progressive power - while at the same time giving space and momentum for further reforms. Consider it along the lines of a Gramscian passive revolution.

It has to be carefully done. For example, it change on conditions happens quickly and change on structure happens too slowly and you end up with powerful HMOs and insurance companies and corporations with the upperhand while the people who would benefit from a single-payer system are not as motivated because their conditions have improved somewhat and are looking at other issues. This ties into the point above about changing institutional structures (in society, politics and economics) as you strive for better policies to improve conditions.

There's only so much time that a movement / political force has before the backswing begins (30-40 years?) - though if this progressive one that's beginning can figure out a way to keep from entering into an idiotic war that will cause it to end, that might do a lot of good in extending its length as far as possible.

would also add the shock therapy approach-- the Powers That Be can force top-down change that would normally be resisted by packaging it as a response to a recent crisis.

Some of the most recent examples, from the Publisher's Weekly abstract on Amazon: the corrupt sale of Russia's state economy to oligarchs following the collapse of the Soviet Union; the privatization of New Orleans's public schools after Katrina; and the seizure of wrecked fishing villages by resort developers after the Asian tsunami. Although Klein focuses on economic change, I'd add the Patriot Act as another example, and the (s)election of W (the crisis being the breakdown/corruption of the voting system in Florida).

Obviously this isn't the kind of change we are hoping to enact, but in a discussion of how change happens, it seems relevant.

What Naomi is writing about is a form of Gramscian "culture war"/"war of position" in which a political/ideological movement seeks to grain control over the institutions that define cultural and political reality.

The "Shock Doctrine," as articulated early on by Milton Friedman, explicitly depended on the "ideas that are lying around," when a shock is experienced, which is precisely what control of reality-defining institutions produces: a limited menu of options and ways of thinking about problems and solutions.

Thus, one can understand "The Shock Doctrine" (Naomi's subject, not her book) as a specific refinement of Gramsci's concept adopted for the particular, highly unpopular ideological agenda that Friedman had.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

One question that lingers with me is where the ideas are lying when they are "lying around"-- are they lying around in govt think-tanks and university (like Friedman) or the public consciousness (Gore, maybe?).

One of the things that I found unnerving about Klein's book was that in so many of her examples, public opinion just fundamentally didn't matter. It was 100% "position" (as I'm guessing you/Gramsci mean it) that effected change. And you know, as an American, I'm used to pretending public opinion counts for something, despite the past 8 years.

I don't have an answer, and I'd love to hear others weigh in, but I think the placement of ideologues matters a lot. One major disfunction in DC and American discourse in general is that pragmatic centrists (they're called center-left, but don't deserve the name) are balanced with Right Wing ideologues. This is true in elected and appointed government, in think tanks and in the media. It's Brookings v. Heritage, Hannity v. Colmes.

If there had been people who were actually ideologically invested in a liberal/left point of view in charge of "cultural institutions" when Katrina happened, things would have looked very different. But no one in power ever articulated a real left/liberal vision for reconstruction. That's why the institutions that promote and place people who are actually serious about left wing policy are so important.

I guess I'm kind of rambling, but my point is that those ideas are "lying around" in powerful people's heads. If there's a network of people in a variety of powerful institutions who are in communication with each other and capable of promoting a positive vision together, they'll do it. Right now the Right has that, and the left has... James Carville and Alan Colmes.

(1) I agree wholeheartedly with your first point about non-exclusivity. In fact, I think it's a given that any theory of change worth it's salt must be a theory of change about how the different enumerated strategies fit together, what's most important, how it relates to the other elements, etc.

For me, #6 is the most important of those you have listed (though see #4 below), simply because it's what ensures that we can keep moving forward with the other strategies, and not end up getting sidelined.

(2) The theory of change for one problem need not be the theory of change for another problem. As you note, there are differences in how hard problems are. There are also differences in the obstacles and things in our favor when it comes to the hard problems, so it follows that the relationship of the elements involved may be different from one issue/problem to another.

Thus, I am willing to argue about what's the most important element on a case-by-case basis, even though I think the answer is the same across the board.

(3) This also impacts the question of timelines, and incremental steps moving us forward in various different ways. The viability of state-level programs as demonstrations for building on, for example, may make a lot more sense for one problem than for another, even if in theory it seems equally useful for all.

(4) I would add one more theory of change into the mix, and that's the counter-hegemonic Gramscian "culture war"/"war of position". This is not the same thing as the more amorphous "6. The more powerful progressive movement theory.", although it's certainly compatible with it, and gives it a more concrete form, as well as higher ambitions than others might envision.

What distinguishes it is key elements such as a focus on institution-building, intra- and inter-institutional organizing, messaging, high-level coordination, long-range planning, funding and strategizing, etc.

Everything I said in #s 1-3 applies to this as well. Understood properly, the Gramscian "culture war" encompasses all the rest, but inevitably people will lose sight of this, so it's a good idea from the get-go to avoid presenting it as "the" solution.

In order to preserve the importance of all the elements, and the importance of diverse critical perspectives, even though I see them all subsumed under a Gramscian approach, it's important to avoid having it overshadow the others in a way that routinizes our thinking about them.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

I would add another (perhaps simpler?) theory (or is it just a strategy?) of change that I think fits in nicely with yours, and with "The more powerful progressive movement theory."

It was quite a while ago but Chris had a really important post (http://www.openleft.com/showDiary.do?diaryId=1809) on positive feedback loops. Basically, policies to pursue that strengthen the ability to further push progressive policy. One aspect of the culture war in action. I followed up with a diary that compiled the many ideas people offered in the comments (http://www.openleft.com/showDiary.do?diaryId=1826).

I don't think it's a theory of change all by itself, but it certainly helps us understand where we should prioritize, and what we can sacrifice and what we can't in the inevitable compromises we're forced to make. That's why amnesty, er, "a path to citizenship" is so damn important, and why the EFCA should be our number 1 priority.

When I think of this problem, I imagine every person on a scatter plot, with more liberal to the left and more conservative to the right.

My basic assumption is every move to the left is of equal value. Getting some redneck to stop calling everyone a Communist who doesn't think healthcare in the US is the best in the world (say moving from 10 to 9) is just as valuable as getting a moderate to consider more government intervention in health care (6 to 5) as getting a liberal to embrace single payer (3 to 2).

What it takes for each of those moves, though, is completely different. These people all listen to different information and have wildly different filters and prospectives on the world.

Now here is the problem. Often, we judge something by its absolute value. We'd all say that something that promotes a value of 9, say, as something bad. But if the only people hearing that message are at 10, then it was actually good.

This is where we get to things like Gore's climate change ad. Clearly, putting Newt on the ad should help those on the right open up to fixing climate change. But it also promotes Newt, so which effect is greater? I actually find myself more on Gore's side on this one, but I certainly see the negative trade-off.

None of this answers the question, but I think it helps understand the scope of the issue.

Also, there are some who would disagree that all moves to the left are of equal value. If you only need 50%+1 to pass something, then only those on the boarder matter. That would be the DLC take, if I give them the benefit of the doubt.

I would disagree with your "equal value" premise, but I think it's still a very useful first approximation, and for many purposes a first approximation tells you most of what you need to know. However, there are other purposes for which it can be utterly misleading.

An exmaple of its usefulness is in highlighting how each of different numbered alternatives can have something to say for itself, and needs to be ackhnowledged as having some legitimacy that needs to be evaluated with respect to the particular issue.

An example of its limitation is precisely what you yourself cited--for something that merely needs a 50%+1 one vote, the moves from 10 to 9 are clearly not equal. The moves from 2 to 1 might not be equal, either, unless those moves translate into intense activism that's also saavy and effectively moves others across that 50%+1 threashold.

In short, as a Jamesian pragmatist, I really like the generality of this assumption, even though I think it's generally false. It seems like just the sort of clarifying assumption that can then be modified for cases where it seems to fail, and continue to yield interesting and important insights.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

I'll admit I think of social liberalism much more than I think of economic. On the social side the approximation is much better because we really aren't talking about laws most of the time, just how we treat each other.

(This is why I often defended groups like Promise Keepers to my friends. I hate the final destination, but they were targeting bear-guzzling husbands and fathers that take no responsibility for anything. Definitely a net improvement.)

For any specific issue, like passing a specific program, for example, it gets much more complex. For one, the graph isn't just one dimension. Then you need a good idea where the important players (senators, voters, everyone) exist on the graph and what you need for the desired final result.

But the key point is everyone is at a different place and requires potentially different motivation to move. The move is always relative even if the goal is absolute.

(1) "Social" vs. "Economic" is the real cut-point. Conservatism defines itself in terms of identity, aka "social issues" while liberalism defines itself in terms of equality (aka "liberty and justice for all") trasnscending indentity, which has supermajority support in the economic sphere, and can only be defeated by defining politics in term of the identity (aka the "social"). So one also has to confront the issue of how politics is defined.

(2) The Promise Keepers are actually a much more complicated case, as you may well know, if you've read Susan Faludi's Stiffed. As she tells it, the women get much more out of it than the men.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

if you take a look at books like Twilight of Equality by Lisa Duggan or Wages of Whiteness by David Roediger, you see how intricately tied together the "social" and the "economic" really are. The societal hierarchy is the societal hierarchy and class has identity markers to it just as race, gender, sexuality, and other identity markers have economics attached to them. So we can talk about capitalism or patriarchy at analytical lenses but at the end of the day, there's just one reality that we're looking at. This is one of the things that the Right understands EXTREMELY well - and the progressive and radical left need to understand as well.

This is where a lot of "progressive" analyses of Obama in the "hope" period (including my own) fell apart - to put it really crudely - we put too much emphasis on the value of a person of color getting elected and failed to pay enough attention to how the elite in the U.S. is being reconfigured to include the multicultural elite (Obama, Clinton, Jindal, etc.) with the same bad policies. but the reason that this worked on us was because the way that the political system offered its choices to us took advantage of the identity-based grievances to justify classist economic policy and provide renewed legitimacy to the system. On the other hand, it still represents genuine progress (in fact, that's the only reason it works).

Because if it could, Obama would be a little more cautious about articulating why White working class straight people turn to non economic grievances - guns, religion, etc. are NOT just a false consciousness, but simply consciousness after a certain point. And it's why the elitist charge used to have a a ring to it (among other things), because upper classes believe their culture is "better" than the lower classes in the U.S. And Democrats in general, i think, would choose their battles more carefully and be less wary of the superficial stuff in liberal ideology (church/state separation in school prayer before a football game) and pay more attention to the combination of social, economic, and cultural power being leveraged to destroy the substance of those underlying ideas in order to ressurect them or something as good in their stead.

we really aren't talking about laws most of the time, just how we treat each other.

These two things are invariably intertwined. If racism is more prevalent, it makes it easier to have discriminatory laws like differential sentencing and create differential impacts through things like the death penalty. Meanwhile, the laws themselve can promote decent social norms or unjust social norms (e.g. the way that different legal decisions on high school students' newspapers' freedom of speech will influence the ways in which they behave as adults). Though in the U.S. I do think the laws follow the social norms most of the time rather than the other way around.

It was only their profound narcissism that made them think the laws were directed at their morality--or rather lack thereof. It wasn't the least bit about them. If they had wanted to get up and emigrate back to wherever their ancestors came from, it would have been just peachy fine with us.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

most of them (definitely someone like karl rove) was fully clear that it wasn't HIS morality he was legislating - it was someone else's. Probably someone working class or middle class. The only way to conscript such a person into the agenda of finace capitalism and rich people's cronies and beltway politics is through appeals to ideology like the contract with america and to their ideology, while depicting Democrats as the "other" that somehow doesn't get those ideologies (Democrats in those days being relatively less sympathetic in symbolism to the broad base of White working class families than they are these days, for better or for worse, even if they were moreso in substance). But as with the Communist Party of India (Marxist), it seems they abandoned their commitment to the substance late in the game and as a result, are going to have to reconfigure their game late in the day given that the world economic system is about to put a world of hurt on the poor people of this world and the lower classes in even rich countries (hello home foreclosures and massive credit card defaults). So they'll have to figure out a way to rejig their philosophy more rather than less quickly to be more populist and less "How I learned to love free trade."

Thankfully, they're better suited for it than the Republicans, which means things are looking up.

The things you're talking about as being hard are hard because they mean restructuring significant parts of our economy. The military bit is doubly hard because of its potent symbolic/tribal value, carbon because of decades of infrastructure and land-use policy. In that sense, health care is possibly the lowest-hanging fruit for real change.

In real terms though, none of these things will change unless the market structures around them change, and the market structures currently support an enormous amount of wealth and power.

Wealth and power does not self-dissolve under normal circumstances. Ergo, as someone above noted vis-a-vis the Shock Doctrine, I would argue that extrordinary circumstances are required, probably outside an election, to drive really big change.

Incremental work and movement-building and electoral success can lay the foundations, and even achieve good results through bureaucratic or procedural means, but making a major break with an existing path requires a watershed of some sort too, a catalyst.

I've been hoping that come November, President Obama uses the gas prices as a kind of extraordinary circumstance to push through real change in energy policy, preferably in a way that takes on all associate environmental, economic, and international relations issues as well...

It might not be 9/11, but Americans having to pay $5+/gal. is a kind of crisis, I'd think.

wealth and power don't dissolve, but they can be discredited
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and then their growth at minimum and possibly their current state can be reallocated. You've already had massive psychological and economic shocks (the flooding of new orleans, iraq war, economic bubbles collapsing, economy as a whole suffering - and if it had been less fraught with religious symbolism and national security, the 2001 attacks could have been included in this category as well). All of these have made people more receptive to the slowgrowing problems that they face from a progressive lens (global warming, health care) - and now the trick is to get the RIGHT solutions to these problems.

Because the problems themselves - infrastructure, health care, global warming, are so glaring and universal that even big business is on board now, or will be shortly, if only out of political expediency. This is why you see things like billionaires against Bush--doesn't really serve the economy or the rich that well when people have to duck cranes falling on their way to work. So when that crucial point comes when it's not just about convincing people but about a real divergence in interests among progressives, the people affected, big business, and others, and people need to be working towards more long term solutions that they can fight for at that point (like single-payer health care), build their policies now so that they won't structurally impede those solutions later, and more broadly be aware that such a disjuncture will come - 10 years, 20 years, 5 years, 30 years down the road.

The reason I support a social movement is because it's the only way to keep progressives with power marginally accountable to the disempowered who are affected by issues rather than simply being able to discuss them. Social power and whatnot.

Probably obvious to state this, but I think the way to get there is with a strategic proposal today that has elements that grease the skids for single payer later.

In Obama's plan, which I haven't read closely, isn't there a 3rd option, a choice of enrolling in an undetermined government plan? Wouldn't this be a "back door" to Medicare?

Or wouldn't proposing a "Medicare 55" or 50 be a strategic extension? I'm sure there are other possibilities.

I think that once universal coverage sets in, people will be surprised, and pleased, and subsequently open to more and different proposals that address cost control. The barn door will be open.

This voter/citizen satisfaction with a gov't solution is what conservatives fear most. But I seriously can't imagine it not happening. The pressure keeps ratcheting up. The system will break in one way or another.

Edwards specifically and intentionally did. Where people could opt-in to Medicare plus if they so chose.

Clinton I think adopted this as well by saying people could buy into Medicare.

I think this is the way to get universal health care. Let people opt in to Medicare. You could, say double their Medicare payroll tax or up it by 50% if they're under 65. That would still be far far cheaper than any individual health plan. For instance if I could do that by doubling my Medicare tax, I'd pay about $50 a month for health care versus $200-$400 /month for a comparable plan on the private market.

Plus it would help shore up medicare in general because you would get an infusion of revenue for the program from the healthiest cohort of people in society.

That was THE biggest disappointment for me with Obama during the primary. The fact that this is such a simple no-brainer way to simultaneously fix medicare and provide truly universal health care to people. Fine if he doesn't want to mandate, but at least let people opt into it if they want to.

you asked if there was a back-door option in his plan. So I told you. No. They specifically said it wasn't a back-door plan to single payer.

I think that says something about the policy people that he's brought on board. If they truly did it just for political reasons to differentiate themselves from Edwards in the primary, OK fine. Let's just say I hope that's all it is.

Because if he proposed a way for people to opt-in to Medicare I think it would be a game changer in terms of people seeing a tangible immediate benefit if they voted for Obama. Especially when polls show a majority of Americans already want to the government to provide health care for all.

I've heard of a similar legislative strategy, called "5 easy pieces", that tries to narrow the gap of people not covered by Medicare by enacting smaller and simpler measures. Start by enrolling all children under the age of 18 (the cheapest to insure, incidentally); allow anyone above 55 and under 25 to buy in; and now you're left with only a 30-year gap of people not covered. Gradually raise the buy-in age, perhaps allow state or local governments to enroll their employees in Medicare, and so on.

Of course, it's not clear that enrolling all children in Medicare is really such an easy piece, but it's an idea.

One thing I would like to highlight is that there's another theory of change in the process of being developed, what I'll call the "networked/diversity" theory. The underlying theory here is based in network research and diversity theory. The two-part claim is

2) the interaction between social computing technologies diversity (both cognitive and identity, and taking into account the complexities of intersectionality) potentially allows the power of social networks in a self-reinforcing way.

On the activism side, Voces Contra Las FARC is by far the biggest proof point for this theory so far; Get FISA Right springs from this tradition as well. And I really do see it as a complement to the other ones you've got listed ...

is that the reason we keep getting bad outcomes is because the process is broken. Fix the process, and you'll start getting better outcomes. Hence Obama's interest in campaign finance, ethics legislation, net neutrality, and other things along these lines. (Where is he on media reform?)

take climate change. we have a really short time horizon if we want to avoid big problems. so at the least that rules out "better Democrats" unless we can somehow elect a much larger number of them in 2010 than now seems likely. that's not impossible but i don't think it's a good bet.

if you can't replace your current elected officials, you have to somehow affect the actions of the ones that are there.

trying to think of what has changed the votes - not the rhetoric - of Congress in the past, the only things i can come up with are: elections (trying to position for upcoming elections and adjusting to the results afterwards); leadership pressure; and external shocks.

i don't think that public opinion per se has ever changed anything, only the perception of how it might affect someone's chances at getting re-elected, and the number of "superpartisan" districts that are almost always a lock for one party sets a pretty high barrier there.

and there's the rub. we can't create leadership pressure, as we have seen time and time again. elections take too long. and external shocks are, well, external.

a President or the Congressional leadership can choose to make these big changes, and we might then be able to help with visible public support. but we can't really make them do so, in a short time frame. we can go after elite opinion makers to try to indirectly create peer pressure, but again, that hasn't worked out all that well lately.

not everything worth doing is profitable. not everything profitable is worth doing.

As several have noted, the full answer is "all of the above," and, as Paul points out, it makes sense for prioritization of strategy elements to vary based on the nature of the particular issue and associated obstacles, resources, timing, events, etc.

Other things that struck me as useful additions are Josh K's reference to the power of watershed events/catalysts and Crab Nebula's comment about "a strategic proposal today that has elements that grease the skids for single payer later." Crab's point speaks to the more general point that we the need to think strategically, even when taking relatively modest but achievable steps, so these steps make it easier, not harder, to move further in progressive directions at a later point in time.

I also like (but don't fully understand) Jon Pincus's comment that "new technology (SMS, Facebook, Twitter etc.) and business models (microlending for example) fundamentally change things." These strike me as transformative from a "bottoms-up" direction and also potentially synergistic with each other, and with more directly politically-focused change.

Illissius highlights another vital element of sustainable change--"fixing" our political and media systems so they better support healthy democracy. If this element is not achieved we will continue to work with one or both hands tied behind our back. This strikes me as difficult, so it seems like an area where we need to find the most effective and achievable points of leverage, and build from there.

In general, I'm inclined to see the process of change in what is probably a pretty bastardized version of the Gramscian "culture war/war of position."

I might describe it as the combination of "raised and mobilized consciousness" with increasingly powerful and democratizing communication technology. It entails the ongoing growth (evident in every election cycle since at least 2000) of "netroots-friendly" technology and media capabilities. I work as a telecom industry analyst and am convinced that, over time (and at an accelerating pace), the Internet will displace what we know as broadcast and cable TV. That is an historic change, and one that we should leverage to the max, and incorporate as a core (and constantly evolving) element of a change strategy.

While having an enlightened, well-informed, thoughtful and attentive population is not something we're ever likely to achieve perfectly, it does seem possible to shift momentum toward that goal in more positive directions by displacing the mass attention paid to broadcast and cable TV, which tend to debase and distract political awareness. This has been and will continue to be a key role of the netroots, and its expanding scope of alliances with on-the-ground organizers, political insiders and progressive thought-leaders. This has been discussed in prior threads and I think it needs to be a high priority for the coming period of increased Democratic control.

In closing, I'd acknowledge Mike's point about timing and the growing urgency of some issues, including climate change/energy and healthcare, while underscoring Crab Nebula's point about the importance of near-term steps that facilitate rather than distract from long-term goals.

If we integrate this with the long-term "culture war" institution building, tool development and systemic reform, I believe we can garner a broad positive momentum that marries pragmatic strategies and tactics with systemic support for an ongoing process of raising and mobilizing political, social and economic consciousness.

Though I have my concerns about him, I think Obama has an appreciation of this multi-faceted change strategy. So part of what I think we need to do, assuming he's elected, is to help evolve his (and our) understanding of it and to back him up when he needs it, and push him hard but constructively when we think he's doing the wrong thing.

Economic subsidies and regulation to encourage or discourage actions. Eventually you can nudge the system in the right direction. For example, gas tax increase to subsidize energy conservation, alternative energy and mass transit. Create a stable regulatory and financial environment for wind or solar investors.

This is not particularly radical, and fits within the normal workings of the system.

Speaking directly to the health care issue. Because radical change is scary and well, disruptive, some kind of phased-in solution is far more likely than a radical transformation. Tax increases are hard to support, even if the overall costs improve.

Given the dramatic nature of the change and the widespread impact I think we need more like 66% +1.

You can imagine a number of mechanisms for gradually moving to single payer. These could include:

(1) Competition Option. Permit buy-in to Medicare Plus in competition with private insurance (as mentioned above). This would require serious regulation of insurance to prevent them from gaming the system. Trouble with this is that if you leave insurance companies in place, you also leave in place the 20% insurance company overhead, and the 10% doctors office overhead. Insurance companies are pretty skillful at filtering out the expensive, high-risk people, which is one reason single payer advocates have been so critical of HCAN. But, with proper regulation, you could imagine that the competitive advantage would go to the Medicare Plus system. I guess that Insurance companies would fight this one tooth an nail, so you'd have to pay close attention to the details.

(2) Age bands: First all children, then all college students, then... Funding SCHIP should be easy with a Democratic President, and majorities in the House and Senate.

(3) Job Categories: First all public workers, then all unionized, then all farmers, then self-employed, then... (I believe this is how the French system came into being.)

(4) Segmenting the Health Care delivery: First Primary Care (cheap & very consequential!), then chronic conditions (diabetes, arthritis, etc), then mental health, then basic dental care, then major medical, then.... hmmm, maybe we're done. The advantage here is that you eliminate insurance companies from a whole segment at a time, so for example, primary care docs can drop all their wasteful staffing that deals with insurance company hassles.

The last one should be credited to Barry Keene, of Health Care for all Colorado, who mentions that you can use treatment categories (ICD-9 codes) to define the segments. So you lump together all the treatment categories that correspond to primary care, chronic conditions, etc.

Reflecting some of the thinking of Sam L and Crab Nebula above, it is also really important to build for future movement towards progressive solutions. For example, if we fully fund health care for everyone through the insurance companies, then we are setting up a situation where the government is giving our tax dollars to the insurance companies, which will make them much stronger (and more difficult to fight later). But if we reduced the age that people could get Medicare to 60, then the amount of money going to the insurance companies would be reduced, and they would be weaker. Clearly, the second route is better in the long run.

Also, if we push for single-payer health, then we could form coalitions with conservatives who say they want the government to be more efficient and cost less (since overall costs could be reduced by 20%). But if we support expanding government payments to health insurers, then these conservatives will fight us. I'd rather have these conservatives on our side fighting the insurance companies than embracing the insurers.

This whole topic is interesting, and I don't pretend to be enough of a theorist to make any very original contribution. I'm simply a direct care nurse and union activist and single payer activist and come to the whole thing from that background of personal and pragmatic experience.

I'd like to comment in particular about this:

Second, one thing I am not clear about with the folks pushing for the strongest left position on the big issues, like the single-payer folks on health care, is their theory of change. I would be very interested in having a dialogue about it, because I love the idea of a single-payer system, but have never heard a theory I found reasonable regarding how we actually get one anytime in the next decade or two. If those of you most passionate about single-payer have some thoughts about that, I would love to hear them.

The gist of this seems to be at least tacitly supporting the idea that we should not be fighting for single payer if we can't see a clear path to winning it. My response to that comes mainly from my experience with union contract campaigns. In those campaigns, we make our assessments of what our members want in a given area. We formulate an ideal proposal based on those assessments. We build support for that proposal, based on the idea that it is fair and right and possible. We take that proposal to the bargaining table. Management rejects it. We find ways for people to show their support for the proposal - petition campaigns, wearing buttons, rallys, marches, letters to management and to the local papers. Management makes some movement in our direction, but not enough. Perhaps we take a strike vote. Management makes more movement. At some point, management's proposal may get good enough that we think it's the best we can get and we go to our members and recommend they accept it - even though it is rather less than the original idealized proposal (At this point we often have a challenge managing expectations and convincing some of our more radical members that this really is the best possible.)

Now: At the start of the process, we on the bargaining team often have a pretty good idea what is the best we can get out of management, and what is the least we would settle for. Suppose for a minute we took that judgement and put it on the table as our initial proposal. Could we build as much support? Could we end up with as good a result? Not bloody likely!

No single grand plan that anyone proposes today on healthcare reform is likely to be the final thing that gets passed in the new congress. In all honesty, what comes out of the sausage machine will probably be some sort of compromise not all that well loved by any of us. But will we not acheive a better compromise by beginning with advocacy for the ideal than if we begin by advocating for a compromise?

Said another way: The HCAN and Obama and other similar approaches all depend to varying degrees on regulation that will attempt to make the insurers behave as good coporate citizens. Right now, such regulation would be all downside for the insurers, since their whole business model depends on their being very bad citizens indeed. But if we succeed in building a strong movement of people calling for their total destruction, then accepting regulation that makes them better actors begins to have an upside for the insurers - the upside being their survival.

Galbraith chimes in at the end of the discussion and frames the contrast between policy and propaganda nicely.

I think Palley's point is that change only happens when things get so bad that the public is open to bold new approaches. The practical question for these days is have we reached such a point or are will about to?

As far as I can see discontent is still muted in this country, the wars don't directly affect many people, inflation is hurting only those at the bottom (who tend to vote less) and unemployment has not yet reached troubling levels.

It is true that lots of people are losing their homes, but the majority of them are also in the lower economic brackets and thus tend to vote less as well.

You will know that a threshold has been crossed when we see demonstrations in the streets that the media decides to cover. Notice the large number of books just released about the broken government and the way congress focuses on re-election rather than legislating.

This is the current game and those who will be getting newly elected haven't made changing the system part of their agenda. I don't know what the catalyst for change will be, but we haven't seen it yet.

that fit together into a grand philosophy around which to organize a society. We must make a clear and understandable case for this philosophy to the public. Before major change will be accomplished, the ground must be prepared.

After Conservatism fell into ill repute after Goldwater and Nixon, many in their movement understood that they had to create a "product" to sell before worrying about how to "sell" it. They had to articulate (or "frame" if you are into the current lingo) a consistent and seemingly coherent worldview to support their policies and goals. Thus were born the Heritage Foundation, AEI, Cato, and dozens of other so-called think tanks, whose sole purpose was to create a seeming intellectual basis to make Conservative policies sound reasonable, wise, and attractive (as Eisenhower's Secretary of State, John Foster Dulles, once famously said, "... somehow we find it hard to sell our values, namely that the rich should plunder the poor.").

Over four decades, the right-wing think tanks and issue groups have changed the intellectual landscape and taken control of the conversation on economics, social policies, taxes, government, war, and the entire panoply of "political" thought.

In the '60s, young, bright college students were exposed to a wide range of rich ideas and provocative viewpoints on the Left that appealed to their intelligence, intellect, compassion, and curiosity about the world. However, the Left as an intellectual inspiration has degenerated over the past 30 years to be replaced by the pseudo-intellectual chaff spread by the multitude of pseudo-scholars at the growing number of pseudo-think tanks. One aspect of this effort was a commonality of belief and a dedication to creating a single, monolithic, internally-consistent philosophy of political, economic, and social values that could replace the old Progressive philosophy of the 40s through the 60s.

Young intellectuals of the 80s, 90s, and today found all the exciting (or seemingly exciting) new ideas coming only from the Right. There was simply no other field for their minds to play in, and so, the late-night discussions in dorm rooms were about the Laffer curve, privatization, deregulation, Friedmanite free-market economics, the "evils" of "big government," the "counter-productiveness" of social welfare programs, the "unfairness" of affirmative action, the "socialism" of an empathetic community working for the public good, and the virtue of libertarian individualism.

In his essay "The Paranoid Style In American Politics," Richard Hofstadter, talking about the politically paranoid Right wing of the 1960s wrote:

"A final characteristic of the paranoid style is related to the quality of its pedantry. One of the impressive things about paranoid literature is the contrast between its fantasied conclusions and the almost touching concern with factuality it invariably shows. It produces heroic strivings for evidence to prove that the unbelievable is the only thing that can be believed."

Meanwhile, much of the Left I remember from my youth was busy marginalizing itself, largely reduced to obscurantism and abstruse and arcane debate within the movement over points of doctrine that were inaccessible and incomprehensible to the rest of the society.

It is telling that several of the most noted and respected intellectuals of today's Left who have any intellectual traction with the public at large are still the same people, like Noam Chomsky and Howard Zinn, who were among the driving intellectual forces of the New Left of the '60s and early '70s. Where are the new Chomsky's and Zinn's?

Another problem Progressives have is that, while the Right spends all its money and efforts selling its single worldview to the public at large, the Left is more focused on achieving immediate results on disparate problems right in front of them - feeding the hungry, protecting the whales, supporting minorities, etc.

Today's progressive movement is fragmented into dozens of "interest groups," each concerned primarily with their own narrow cause or causes. There are feminists, animal rights people, pro-choice crusaders, minority advancement movements, ecological movements, and so on. We just saw the results of a self-destructive primary campaign where the feminists and the minority supporters came virtually to blows over the relative importance and relevance of their particular causes.

All of the time, the Right has continued to pour its money, effort, and "scholarship" into creating a propaganda designed to frame the American political discussion, the Progressive Left has been, for the most part, busy working for their narrow causes, trying to organize movements to deal with specific issues. This is admirable, but does little to inculcate the larger population with our values.

Today, we talk about how to create change - but change to what? We certainly have issues we want to address, like single-payer health care, cutting the military budget and activity, restoring progressivity to taxation, rebuilding public education, curbing corporate excesses through regulation, laws, and re-establishing unions, fighting global warming and implementing clean renewable energy.

But, each issue exists on its own lonely pedestal. Before we are going to effect real change, we have to create, defend, and spread a philosophy and value system that ties all of these together. We need to articulate a philosophy that makes the social welfare state desirable - the Social Democracy we see in countries in Europe and, particularly Scandanavia - and do it in such a way that the average people of our society can understand and embrace it as desirable - as do the people of Norway or Denmark or France.

We need to convince people WHY public cooperation and public institutions are, in truth, better than individualism and the private marketplace for dealing with most of society's problems. When we do that, the mechanics and tactics of change will be easy.

We have, I fear, wasted decades on the defensive and, as a result, can do little in the near term save try to rein in some of the more egregious excesses of the current American political system.

But, we must also look to the future and begin, as the Conservatives did in the '70s, to create a body of scholarship that defines a complete philosophy of Life, Politics, the Universe, and Everything.

"If you want to build a ship, don't herd people together to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the sea.